Purpose:To study the effectiveness and safety o f first-line chemotherapy with GEM-Cis 3-week regimen in routine care of Chin ese patients with advanced NSCLC. Methods:Gem-Cis 3-week regimen was used as first line chemoth erapy to treat stage Ⅲb/Ⅳ NSCLC patients, measurements of effectiveness includ ed clinical benefit and significant clinical response (SCR), and side events of GEM-Cis in the treatment of stage Ⅲb/IV NSCLC. Results:221 patients with cytological or pathological confirmed stage Ⅲb or IV NSCLC were enrolled, 209 eligible for effectiveness and safety analysis. Median age 58 years (range, 29 to 79 years); males: females, 67.5%∶ 32.5%; stage Ⅳ: ⅢB, 52.5%∶47.8 %; KPS

Objective To evaluate the long-term result of jejunum-interpositioned choledochoduodenostomy with a antireflux valve after resection of choledochocele in 178 patients.Methods Postoperative patients were followed up by barium series of the upper digestive tract at different interval. To observe whether reflux remains and the severity of the reflux.Results142 out of the 178 cases (798%) were followed up, among them 21 cases (48%) without reflux, 26 cases (83%) with mild reflux, 51 cases (359%) with moderate reflux,and 28 severe cases(9%).16 cases(11.3%) had to undergo reoperation.Conclusion The technique has the effect of anti-reflux temporarily.Long-term follow-up found an increased morbidity of biliary infection, obstruction, perforation and stone formation.Severe postoperative complications necessitates a reoperation in some cases.

Objective To study the operative methods and clinical outcome of laparoscopic ileal colpopoiesis with long vascular pedicle.Methods We reviewed 31 cases which had received ileal colpopoiesis,including 25 cases of congenital absence of vagina and 6 cases of male-to-female transsex.All cases were operated on by laparoscopic(8 cases) and laparoscopy assisted(23 cases) ileal colpopoiesis.The postoperative results were analyzed through physical examination and interview regarding the patient′s functional status and satisfaction during sexual intercourse.Results Ileal colpopoiesis were preformed successfully on all 31 cases.Follow-ups of 3-13 months were done for all of them.Patients used vaginal mould for at least 8 months.All artificial vaginas had excellent cosmetic results,including adequate vaginal length,good lubrication,and appearance and physical functions similar to female natural vagina,and sexual function was reportedly satisfactory.One of the patients had an operative complication of an intestinal obstruction,which was cured by a second operation and other treatments.Conclusions The laparoscopic and laparoscopy assisted ileal vaginoplasty is a feasible,safe and ideal method of current vaginoplasty due to its minor damage,excellent cosmetic results and similarity to normal vaginal features.However,vaginal mould should be used for a long period of time(at least 8 months) after an operation,to prevent vaginal orifice shrinkage.

BACKGROUND: The postnatal sexual health of women is crucial in reproductive health, due to lack of sexual knowledge and sexual heath care service as well as conventional idea, the medical staff and postnatal women themselves pay little attention and discussion on the sexual health after childbirth.OBJECTIVE; To investigate the prevalence and types of women's sexual problems after childbirth, identify the factors associated with dyspareunia and investigate the status quo of postnatal sexual health care service. DESIGN: Cross-sectional study and follow-up survey within six months after delivery.SETTING: Department of Reproductive Medicine, Chongqing University of Medical Sciences. PARTICIPANTS: A total of 798 primiparous women delivering a live birth in Department of Obstetrics at the First Affiliated Hospital of Chongqing University of Medical Sciences between November 2000 and July 2001, and 79 husbands who accompanied their wives during the follow-ups were adopted in this study.METHODS: The primiparous women after 6 months of childbirth and husbands conducted routine postnatal follow-ups and were informed of the follow-up content. The interview was used in this cross-sectional study and the questionnaires were finished under the help of health professional. And some advice, consultations and treatments can be given in time. MAIN OUTCOME MEASURES; ①main change of postnatal sexual life;②postnatal sexual problems and related factors. RESULTS: Totally 460 out of 798 primiparous women in accordance with the inclusive and exclusive criterions received follow-up surveys after telephone or letter notification. ①Main change of postnatal sexual life: Of the 460 respondents, 94.74% had resumed sexual activity within six months after delivery. Compared with one year pre-pregnancy, the number of sexual activity decreased obviously within 3-6 months after delivery, and 66.0％ of postnatal women decreased the sexual desire.②Postnatal sexual problems and related factors: Sexual morbidity increased significantly after the childbirth: In the first three months after delivery, 70.6％ of women experienced sexual problem(s), declining to 55.6％ during the 4th-6th months, and reduced to 34.2％ at the 6th month, but not reaching pre-pregnancy levels of 7.17％. The sexual problems of women after delivery included dyspareunia, vaginal dryness, orgasm disorder and vaginal relaxation, etc.4. And dyspareunia was the most common type. Between the 4th and 6th month after delivery, dyspareunia was significantly associated with the effect of traditional sexual ideas, experience of dyspareunia before pregnancy and current breastfeeding (P ＜ 0.05), while the association of dyspareunia with delivery mode was not significant.③Sexual care service and sexual counseling after delivery: Only 20.8％ of women received information about sexual health from health care personnel within 42 days after delivery, and consultation rate of sexual intercourse problems was 8.0％.④Husbands' comprehension of postnatal problems in women: Only 59.2％ of partners whose wives had postnatal sexual problem(s) knew that their wives had ever experienced sexual problem(s) and 8.1％ of partners had sought medical help. CONCLUSION; Sexual health problems are very common in women after childbirth, taking up for 70.6％. And the quality of postnatal sexual health is unrelated with delivery mode, but postnatal health care service are often overlooked, additionally lack of professional counseling and treatment. The current practices of encouraging the husband's supports after the childbirth may well influence the prevention and treatment of postnatal sexual problems in women.

Objective To investigate whether lipids and reagents would interfere the results when serum total bile acid(TBA) was measured by enzymatic cycling assay.Methods The serum TBA was measured by enzymatic cycling assay.The carry-over contaminations of high density lipoprotein(HDL-C),low density lipoprotein(LDL-C),cholesterol(TC),and triglyceride(TG)rea-gents were evaluated.In order to reduce the interference and carry-over contaminations,different washing procedures and detection sequence were set.Results By measuring the levels of TBA in pooled serums with low and high levels of lipids,the results showed that there was statistically significant difference between the groups with and without the addition of cleaning process before and af-ter TBA measurement(P <0.01).Cleaning with water might be more effective on reducing interference than those with acid solu-tion.Moreover,the mean of TBA levels in HDL-C,TC,TG and LDL-C reagents were (476.06 ± 1.88 ),(127.78 ± 1.18 ), (121.05±1.08),and (2.23±0.51)μmol/L,respectively.The stability of TBA level was greatly affected by HDL-C regents,fol-lowing by TC and TG reagents,and was little affected by LDL-C reagent.Setting up proper detection sequence and flushing proce-dures could obviously reduce the interference(P <0.01),but not completely rule out.Conclusion Analysis sequence and flushing procedures of biochemical analyzer as well as exogenous substance from reagents may seriously affect the accuracy of determination results.To ensure the accuracy and reliability of the results,it is necessary not only to set up reasonable irrigation and reaction se-quence,but also to master the instrument operation,to know the principle of test reaction and the components of reagents as well as equipment maintenance.

Objective To improve the sensitivity of PCR for studying the rifampin resistant gene (rpoB) of M.Leprae from clinical samples.Method After comparing the results of PCR with Q-Solution (PCR Enhancer) and without Q-solution,Nested-PCR was then applied for the detection of rpoB gene.Results Although PCR Enhancer improves the amplification of rpoB gene, the sensitivity of routine PCR is only 45. 2%.The sensitivity of Nested-PCR for detecting mutants in rpoB gene can further increase to 90.5% after selection of optimum parameters.Conclusion The combinaion of PCR Enhancer and Nested-PCR improves the sensitivity and specificity of PCR for detection of rifampin resistant gene of M. Leprae.

Objective To study the epidemic and genetic characteristics of coxsackievirus A6 ( CVA6) strains isolated in Guangdong province.Methods Enterovirus strains positive for neither entero-virus A71 ( EV71) nor CVA16 were isolated from Guangdong province during 2008 to 2013 to screen CVA6 isolates by real-time PCR.The entire sequences of viral genes encoding VP1 of CVA6 positive samples were amplified and sequenced.The phylogenetic analysis was performed to analyze the full-length gene sequences encoding VP1 of CVA6 isolates and sequences downloaded from GenBank by using DNAStar6.0 and MEGA5.2 software packages.Results CVA6 strains accounted for 61.4%of the 1672 non-EV71 and non-CVA16 enterovirus strains isolated in Guangdong province during year 2008 to 2013.The positive rates were respectively 10.5%(4/38), 66.7%(34/51), 36.2% (81/224), 63.0% (182/289), 62.3% (325/522) and 73.0%(400/548) from 2008 to 2013 and the differences among different years were significant (χ2=133.79, P<0.01).The CVA6 isolates could be classified into four clusters in the phylogenetic tree, designated A, B, C and D (including D1, D2 and D3 subgenogroups) genogroups.The four clusters shared nucleotide diversity ranging from 15.5% to 23.1%.The CVA6 strains isolated in Guangdong province shared 88.7%-100.0% homologies in nucleotide and 95.7%-100.0% in amino acid.Subtype D2 strains circulated during 2008 to 2012 and subtype D3 strains circulated during 2009 to 2013.Conclusion CVA6 strains were the predominant enterovirus strains among non-EV71 and non-CVA16 enterovirus strains circula-ted in Guangdong province from year 2008 to 2013.The CVA6 isolates could be classified into A, B, C and D genogroups based on the sequence analysis of VP1 region.Subgroups D2 and D3 isolates were identified and the subgroup D3 isolates were the prevalent strains in Guangdong.

Objective To analyse the changes of metabolic parameters and condition of metabolic syndrome(MS)in females with obstructive sleep apnea-hypopnea syndrome(OSAHS),and explore the interaction between OSAHS and MS.Methods Sixty females undergoing polysomnography were included,and were divided into simple snorer group(n=19),mild OSAHS group(n=21)and moderate to severe OSAHS group(n=20).Epworth sleepiness scale(ESS)scores and metabolic parameters were compared among groups.Forty-one patients with OSAHS were subdivided into group with MS(MS group,n=15)and group without MS(non-MS group,n=26).ESS scores,apnea hypopnea index(AHI),oxygen desaturation index(ODI)and lowest pulse oxygen saturation(LSpO_2)were compared between MS group and non-MS group.Results There was no significant difference in age,body mass index(BMI),total cholesterol(TC),triglyceride(TG),low density cholesterol(LDL),high density cholesterol(HDL),apolipoprotein A-I(apoA-I)and apolipoprotein B(apoB) among simple snorer group,mild OSAHS group and moderate to severe OSAHS group(P>0.05).Correlation analysis revealed ESS was positively related to AHI(r=0.327,P=0.011).ESS scores and proportions of hypertension,fasting plasma glucose(FPG)and MS were significantly higher in moderate to severe OSAHS group than those in simple snorer group(P<0.05).BMI,FPG,TG,proportion of hypertension,ODI and ESS score in MS group were significantly higher than those in non-MS group(P<0.05),while there was no significant difference in AHI and LspO_2 between these two groups(P>0.05). Conclusion ESS score may reflect the severity of OSAHS in females.Females with OSAHS matched for age and BMI have no difference in blood fat.With the increase of severity of OSAHS,glycometabolism can be impaired,the prevalences of hypertension and MS increase.MS can exacerbate the severity of OSAHS,indicating that MS and OSAHS interact with each other.

Objective To discuss the prevalence of non-EV71,non-CA16 virus strains of hand,foot and mouth disease(HFMD) in Guangdong province between 2008 and 2009,and analyze the genetic evolution of these non-EV71,non-CA16 virus strains.Methods Isolated viruses from stool samples collected from outpatient and in-patient cases of HFMD between 2008 and 2009 by human rhabdomyosarcoma(RD) cell and HEp-2 cell,cultures that exhibited a characteristic enterovirus cytopathic effect were evaluated by RT-PCR.Those strains which identified non-EV71,non-CA16 were analyzed by VP1 sequencing and then were identified by BLAST program.A phylogenetic tree was constructed using the Neighor-Joinning method in the MEGA 4.0 software.Results Twenty-two virus strains of non-EV71,non-CA16 were obtained,and nine of the twenty-two virus strains in 2008 were classified into CA2,CA4,and CB3 by BLAST; thirteen of the twenty-two virus strains in 2009 were classified into EV80,Echo13,Echo30,CBS,Echo24,CA10,CA6,and poliovirus 1 by BLAST.The honology of all strains was low,and all the strains belonged to CA,CB,Echoviruses,Enterovirus and poliovirus subgroup.Conclusion Except for EV71 and CA16 was a major causative agent in prevail of HFMD in Guangdong province between 2008 and 2009,there also existed other subgroup Enterovirus.The other twenty-two strains respectively belonged to CA,CB,Echoviruses,Enterovirus and poliovirus subgroup,and none of those strains was predominant.Muti-species Enterovirus occurred concomitantly.

Objective To study the clinical effect of laparoscopic vaginoplasty using pedicled ileal and sigmoid colon segment.Methods From January 2004 to December 2009,105 cases undergoing laparoscope-assisted vaginoplasty using a vascularized pedicled intestinal flap were studied retrospectively.Operation time,blood loss in operating,bowel movement after operation,postoperation hospital duration,side effect,and artificial vagina were compared between two surgical management.Results The vaginoplasty were preformed successfully in all 105 cases.There were 48 patients treated by aparoscopeassisted ileal vaginoplasty and 57 patients treated by laparoscope-assisted sigmoid colon vaginoplasty.The values of the operation time [(141 ±22) minutes versus (159 ± 18) minutes,P =0.000],blood loss in operating [(42 ±6) ml versus (83 ± 14) ml,P =0.000],bowel movement after operation (36 ±9) hours versus (68 ±8)hours(P =0.000),and postoperation hospital duration [(9.8 ±2.0) days versus (11.1 ± 1.3) days,P =0.004] in the sigmoid colon vaginoplasty group were longer or higher than those in ileal vaginoplasty group (P ＜ 0.05).No intraoprative complication occurred.There were four postoperative complications:2 cases with intestinal obstruction in sigmoid colon vaginoplasty group,1 case with urethral orifice stenosis and 1 case with vaginal-rectal fistula in ileal vaginoplasty group.At follow-up of 6-62 months,all artificial vaginas had a capacity of over two fingers in wideness and 12-15 cm in length.Vaginal discharges resembled a milky white water or mucus without odour.Fifty-five patients with sexual intercourse reported satisfactory results.Six patients complained vaginal stenosis:5 patients in ileal vaginoplasty group and 1 patient in sigmoid colon vaginoplasty group.Conclusions Laparoscope-assisted vaginoplasty using pedicled ileum or sigmoid colon segment are both the effective ways in forming vagina.The latter management takes more time and blood loss while operating,yet the incidence of vaginal opening contracture appeared to be decreasing trend.